Medical Billing Specialist - Team G.A.I.N. California, Inc.

Seeking a well-organized billing specialist who will be responsible for multiple revenue cycle management functions, who will monitor aging reports, update patients' demographics, check eligibility, and take minimal patient phone calls. We’re looking for a proactive professional who can excel under pressure, working in a rigorous, priority-changing, fast-paced environment that has deadlines with the ability to maintain a professional demeanor; A candidate with a collection of strong written, verbal, interpersonal, communication, analytical, organizational, prioritization, follow up and time management skills are a PLUS! Someone with the ability to work flexible hours, including some weekends.

Minimum Work Experience:

• A minimum of 3-5 years of experience with:
  • Medical biller in an outpatient medical setting (non-hospital) family planning, ob-gyn, and related surgeries required.
  • Electronic practice management system and electronic health record system.
  • Medical insurance billing and coding procedures.
  • Insurance billing and reimbursement procedures.
  • HIPAA 5010 transaction standards.
• Proficiency in MS Office: Excel, MS Word, Outlook
• Advanced knowledge of medical terminology and common industry abbreviations, anatomy and physiology, pharmacology, and pathophysiology
• Advanced knowledge of coding guidelines, policies and procedures.
• High school diploma or Associate’s preferred or equivalent experience in related field.
• Computer database management (electronic practice management system) EClinicalWorks/NextGen experience preferred.

Qualifications

• Advanced familiarity and knowledge of medical terminology and common industry abbreviations, anatomy and physiology, pharmacology, and pathophysiology
• Advanced knowledge of coding guidelines, policies and procedures and computer database management (electronic practice management system)
• 100% commitment to top quality healthcare and excellent customer service with the ability to maintain confidentiality; Demonstrate mature judgment, initiative and critical thinking.
• Capability to read and interpret insurance eligibility with accuracy and attention to detail to determine payer responsibility is a necessity.
• Keen knowledge of Family Planning, Medi-Cal, Commercial, Medi-Cal Managed Care and Primary Care billing
• Ability to multi-task and work courteously and respectfully with fellow employees, clients and patients, keeping a positive energy about yourself in your department while embracing and growing from any constructive feedback with a great team player attitude.

Responsibilities

• Medical Billing Specialist is responsible for ensuring the timely submission of medical claims to insurance companies, including physician offices, payers, medical groups or other healthcare facilities and certifies clean claims, charge posting and billing to obtain accurate reimbursement for healthcare claims.
• Medical Billing Specialist must possess solid knowledge of the billing process from start to finish including in depth knowledge of billing best practices
• Must serve as a subject matter expert and liaison between Management, Billing team and other stakeholders
• Ideal candidate will possess knowledge in Family planning and Primary care billing, as well as have a keen eye to identify billing errors that may result in corrections and when necessary, communicate in detail the directives to necessary parties
• Responsible for entering, and correcting medical claims insurance information into a computer system and generating invoices to be sent to the health plans
• Responsible for compiling and updating revenue cycle management on payer billing and regulatory updates
• Demonstrate a strong knowledge of the payer contracts and DOFR (Division of Financial Responsibility) to ensure that claims are sent to the correct payer

• Maintain the productivity level as established by Management with strong commitment to quality healthcare and excellent customer service is required
• Reviews appropriate documents for billing accuracy, corrects order code (appointment type), Billing Policy for instructions, financial class, demographics, medical records, proper physician information for billing requirements, place/date of service, and notes to determine accurate creation of the patient’s encounter
• Reviews and monitors day-to-day productivity to ensure that billing deadlines are met; Maintains in-depth knowledge of payer regulations and reimbursement methodologies to assure accurate reimbursement
• Keeps abreast of changes in the authorization process, insurance policies, billing requirements, rejection or denial codes as they pertain to claim processing and coding
• Maintains a billing accuracy percentage of 95% to ensure clean claims submission, compile billing and payer documentation to assist management in training tools; communicates with RCM leadership about payer updates, changes, and requirements
• Reviews claims to ensure that billing data adheres to governmental and state requirements for all Family Planning billing including surgery claims; Ensure that all required signatures and authorizations are in place prior to submission.
• Handles information about patient treatment, diagnosis, and related procedures to ensure clean claim submissions; review patient bills for accuracy and completeness, and obtains any missing information
• Prepare, review, and transmit claims using billing software, including electronic and paper claims processing
• Maintains knowledge levels of payer changes as they occur, validate eligibility and benefits verification to ensure that claims are billed to appropriate payers, ensure healthcare facilities are reimbursed for all procedures
• Posts and manage patient account payments, submit claims to insurance within corporate charge posting lag; follow up on claim submissions to determine batch acceptance, rejection, or denial
• Research, correct, resolve, and resubmit rejected or errored claims/services; correspond with insurance companies to resolve issues, communicate with RCM leadership about payer updates, changes, and requirements
• Reviews delinquent accounts and call responsible parties for collection purposes
• Investigates insurance fraud and reports if found, maintains strict confidentiality, regularly attends monthly staff meetings and continued educational sessions as requested
• Handle all problems quickly and efficiently, embraces opportunities to help team members, stakeholders, and other departments
• Creating equitable access and opportunity for all through education, practicing inclusive behavior, elevating others’ voices, creating spaces for honest conversation, and listening without judgment.